INCISIONAL HERNIA INFORMATION SHEET DR. JULIE MILLER BA, MD, FRACS Specialist Endcrine and General Surgen Suite 12, Level 2, The Wmen s Hspital (03) 9347 6301 Yu have an incisinal hernia. Because f yur current symptms and/r findings, and the ptential fr cmplicatins arising frm the presence f this hernia, surgical repair has been recmmended. WHAT IS AN INCISIONAL HERNIA? Incisinal hernias ccur due t a weakness r gap in a previus incisin f the abdminal wall, resulting in a bulge f intra-abdminal cntents and/r pain r discmfrt. Incisinal hernias ccur when the ld incisin des nt heal prperly. It ccurs mre ften in verweight patients, smkers, after emergency surgery, and when there was a wund infectin. HOW IS A HERNIA REPAIRED? Surgery invlves return f the abdminal cntents back int their nrmal psitin and repair f the area f weakness. A plastic screen r mesh (made frm nn-reactive material) is used t safely reinfrce the area in repairing the verwhelming majrity f hernias (bth primary and recurrent hernias). The mesh patch becmes part f the bdy, giving strength and supprt t the abdminal wall. The mesh patch reduces, but des nt eliminate, the chance f the hernia cming back. Small hernias can be repaired under lcal anesthesia. There are benefits t repair under lcal anaesthesia including shrter recvery time and freedm frm ptential cmplicatins f general anaesthetic, like nausea and vmiting, and temprary inability t pass urine. Althugh yu are sedated by an anaesthetist, yu will nt be cmpletely asleep. The sedative makes yu feel calm and restful. The area will then be numbed with lcal anaesthetic. Yu will be kept relaxed, cmfrtable and pain-free during the prcedure In patients with larger, recurrent r cmplex incisinal hernias, general anesthesia may be necessary. 1
WHAT HAPPENS AFTER THE OPERATION? After surgery, yu will be active and able t walk. Patients with small first-time hernia repairs are ffered a light snack, and are usually discharged n the day f surgery safely and cmfrtably. Patients with larger, cmplex, r recurrent hernias will have t stay vernight in hspital. When yu are discharged, a prescriptin fr pain medicatin will be prvided. Beware that pain medicines can cause drwsiness and cnstipatin, s d nt drive, eat lts f fruits and vegetables, drink plenty f water, and cnsider Metamucil r stl sfteners while n pain medicine. Yu shuld keep an ice pack n the incisin the first day t reduce swelling and discmfrt. Yu will have a waterprf Cmfeel dressing in place. Please leave it there until the first pst-perative visit. I will remve it then. Discmfrt, swelling, and bruising in the week r tw after the peratin are nrmal. Recvery and return t wrk and nrmal activity depends n hw large r cmplex yur hernia was and what type f wrk yu d. Yu will be encuraged t be ut f bed and walking within a few hurs f the peratin. This reduces the risk f cmplicatins like bld clts and pneumnia. WHAT CAN I DO AFTER SURGERY? Yu may shwer the day after surgery. Yu can eat and drink whatever yu like, unless I tell yu therwise. Yu can walk, climb stairs, and d light activity withut delay. Activities such as jgging, tennis, and sexual activity can be resumed when yur bdy feels cmfrtable ding them. Yu shuld nt drive r perate heavy machinery as lng as yu need prescriptin pain medicine. I will discuss yur expected recvery with yu and give yu specific instructins fr return t heavier activity and wrk. WHAT IF I DON T HAVE THE HERNIA REPAIRED? While hernias in babies smetimes heal, hernias in adults will never get better withut surgery. In fact, they tend t enlarge and get wrse ver time. Many patients ask abut a truss (external hernia supprt.) A truss may supprt the weak area and prvide sme cmfrt, but is generally ineffective and can cause pressure sres. Hernias can be aggravated by chrnic cugh, cnstipatin, r heavy lifting. Cntents f the hernia, like intestine, may ccasinally becme trapped within the hernia leading t intestinal blckage r damage ( incarceratin r strangulatin), creating an emergency surgical situatin. If yu ntice cnstant severe pain at the site f the hernia, a lump that des nt reduce in size when yu lie dwn and relax, r symptms such as pain with assciated vmiting, yu shuld call my ffice r reprt t a hspital emergency department withut delay. 2
WHAT ARE THE RISKS OF SURGERY? As with anything in life, there are risks t surgery. These risks are weighed against the risks f nt having surgery. Listed belw are sme f the pssible cmplicatins f hernia surgery. Other unfreseen risks are pssible. Risks include, but are nt limited t: Recurrence f the hernia...10% (higher fr recurrent hernias) Infectin f Incisin... 2% Bleeding...2% Serma (fluid cllectin)..5% Injury t intestine r ther intra-abdminal rgans...less than 1% Intestinal fistula Less than 0.5% Chrnic Incisinal Pain**...5% (**Generally mild, nn-debilitating, but severe in sme cases) Kelid r hypertrphic scar Other unfreseen risks If yu require general anaesthetic, it will be given by a specialist anaesthetist. Serius events after anaesthesia are rare. Ptential risks include, but are nt limited t: Heart prblems (death, heart attack, arrhythmias) Lung prblems (pneumnia, wheezing) Bld clts (strke, clts in leg veins r lungs) Drug reactins (als pssible with lcal anaesthetic) Chipped teeth Pst-perative nausea and vmiting Temprary inability t pass urine Sre thrat frm breathing tube (temprary) Other unfreseen risks All surgical incisins may be assciated with sme lcal numbness, as virtually invisible nerves within the skin and lwer layers are divided during the peratin. Mst f this will be temprary; hwever an area f residual numbness arund the incisin will persist. This is generally well tlerated, minimally nticeable and creates n functinal prblems. This numbness may be lcated in the area f skin at r belw the incisin. Yu will have significant discmfrt fr 1-2 weeks after surgery. Chrnic incisinal pain r discmfrt ccurs in apprximately 5% f all surgical prcedures, including hernia repair. This discmfrt is generally mild and usually temprary, lasting 2-3 mnths r less. Mre chrnic pain is less likely. Severe and lng lasting pain at the area f the incisin can ccur, but is nt cmmn. If yur hernia is being repaired fr the secnd r mre time, if yu are bese, diabetic, smke, r n sterids, the chance f recurrence and ther cmplicatins listed abve will be higher. 3
FOLLOW UP Questins: call the ffice n 9347 6301 After hurs emergency: Dr Miller s mbile - emergency nly please Yu will typically return t my ffice within 14 days f surgery fr a check-up. Mst f the time, disslvable stitches are used, s will nt need t be remved. CONTACT MY OFFICE fr any f the fllwing symptms: Fever >38.3 r chills Increasing pain r redness arund incisin Ful smelling r creamy discharge frm incisin Increasing abdminal pain, nausea, r vmiting COSTS OF TREATMENT Insurance rebates have nt kept pace with the cst f running a medical practice. As a cnsequence, there will be a gap t pay fr the surgical fee and fr the anaesthetist. Yur insurance cmpany might als charge yu an excess fr a hspital admissin. We will advise yu abut expected ut-f pcket csts nt cvered by insurance. If these csts represent an undue hardship fr yu, please discuss them with us. ASK YOUR DOCTOR We are here t help yu. If yu have any questins, please ask. It is ften helpful t bring a family member with yu t a cnsultatin, r t write questins dwn s yu wn t frget them. Use this space fr ntes r questins 4
PREPARATION fr SURGERY Please shwer at hme the evening befre surgery r in the mrning. Please d nt shave the surgical site! It will be dne fr yu if necessary. Shaving yurself may increase the risk f infectin. Fr mrning surgery, D Nt Eat r Drink anything after midnight the night befre surgery unless therwise instructed. This includes cffee, tea, water, and juice! Medicatin with a small sip f water is OK. Fr afternn surgery, a small breakfast BEFORE 7AM is OK, and nthing after that. Yur surgery may be cancelled if yu d nt fllw these instructins. D Nt Drink Alchlic beverages 24 hurs prir t yur surgery. D Nt Smke fr 4 weeks befre surgery r yur risk f serius cmplicatins increases. Ask us if yu are permitted t take yur rutine medicatins (such as thse fr heart, bld pressure, r insulin etc.) befre arriving fr surgery. Stp aspirin, warfarin, r any ther bld thinner 5-7 days prir t surgery D Nt bring valuables such as mney, jewelry etc. D nt wear make-up. Bring tiletries and lse fitting, cmfrtable clthing t wear upn discharge. Yu will be required t remve cntact lenses, jewelry, dentures, and wigs Arrange fr a respnsible adult t drive yu hme after discharge. Ntify us if there is a change in yur cnditin prir t surgery (such as a cld, cugh, fever r infectin). If severe, yur surgery may need t be pstpned fr yur safety. Stp all herbal medicatins 4 weeks befre surgery unless discussed befrehand. Especially Ginseng, Garlic, and Gingk, r St. Jhn s Wrt, which increase the risk f bleeding. THE DAY f YOUR SURGERY On the day f yur surgery, reprt t receptin, MPH, Level 1. If yu have nt already dne s, yu will meet yur anaesthetist Yu may need a bld test r ECG prir t surgery After the peratin, yu will sme time in the recvery rm befre ging t the ward After discharge, yu are nt permitted t: Drive a Car nr perate pwer equipment Drink Alchlic Beverages Sign imprtant papers The abve are nt permitted n the day f surgery, nr while taking any prescriptin pain medicatin. Instructins regarding safe resumptin f the abve activities will be prvided by yur surgen. 5
RETURN TO WORK GUIDELINES Unless therwise stated, the fllwing are general guidelines after mst uncmplicated hernia repairs. TYPE A-SEDENTARY JOB DESCRIPTION [ie: Desk, cunter r cmputer related emplyment (standng r sitting), retail sales (invlving n lifting ver 10 kils), shrt distance driving] *Mst patients with SEDENTARY emplyment can safely and cmfrtably return t wrk in 1-2 weeks fllwing rutine hernia surgery. By this time, residual pain is usually minimal and is ften successfully managed using nnprescriptin pain medicatin such as Nurfen T r Panadl T. Emplyment activity can be expected t be essentially nrmal and withut restrictins by this time-frame. TYPE B-LABORERS-Light t Mderate Physical Activity [ie:delivery Persnnel, Maintainance wrkers, Light Cnstructin, Retail Sales (requiring lifting up t 25 kils), Manufacturing, Plumbing and Heating, Mechanics etc. ] Patients in this categry can be expected t return t full emplyment withut restrictins 2-3 weeks fllwing surgery. If available, return t wrk with restrictins fr light duty shuld be cnsidered at ne (1) week. Many nncntact athletes fall int this categry as well. TYPE C-HEAVY LABORERS-Frequent heavy physical activity required [ie: Heavy Cnstructin (lifting ver 25 kils regularly), Climbing necessary (ie Steeplejacks, Cntact Sprts Athletes] Patients in this categry may require 3-4 weeks f recuperatin t return t bth a safe and cmfrtable wrk-place withut emplyment restrictins. If available return t light activity in ne (1) week, r mderate activity in tw (2) weeks shuld be cnsidered. 6